Second-line therapy for gemcitabine-refractory pancreatic cancer: is there a standard?
Gemcitabine (Gemzar) has been the standard treatment for metastatic pancreatic cancer based primarily on clinical benefits. To date, no standard guideline for second-line treatment of pancreatic cancer has been established. Data supporting the use of second-line therapy compared to best supportive care is lacking. We reviewed the published literature on second-line chemotherapy for pancreatic cancer. Most studies were published in abstract form with small numbers of patients. No single drug has been studied extensively in this setting. Benefits of second-line therapy seem to be modest, at the cost of drug toxicity, and randomized phase III trials are still needed. Future studies in the second-line setting should not only use response or overall survival as an outcome measure but should consider using clinical benefit as treatment endpoints. The incorporation of costs, cost-effectiveness analysis, and cost-benefit analysis into these studies should be considered as well.
Almhanna
Khaldoun
K
Gastrointestinal Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Kim
Richard
R
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D009362:Neoplasm Metastasis; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D000093542:Gemcitabine
D003841:Deoxycytidine; D000093542:Gemcitabine